Healthcare Provider Details

I. General information

NPI: 1649915075
Provider Name (Legal Business Name): WEST AMERICA FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S SAN MATEO DR STE 212
SAN MATEO CA
94401-3843
US

IV. Provider business mailing address

550 OLIVE AVE
FREMONT CA
94539-5263
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-5733
  • Fax: 650-342-0525
Mailing address:
  • Phone: 510-517-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GILBERT KO-TSUN HUANG
Title or Position: PODIATRIST
Credential: DPM
Phone: 510-517-0496